To Turn or Not to Turn

First of all, might I mention... being in school is killing my blogging experience. I am prepping for midterms already and have barely been on-line at all for an entire week. I feel like a junkie, dying for my fix.

That said, I haven't stopped thinking about my blog and blog buddies. :-) In fact, I believe it was No Milk who commented that my explanation for the cause of death rattle was not reassuring. This simple comment has sparked a huge tangent in my life outside of cyber space. You see, I had to pick a topic to study for a nursing theory class. And so I chose... death rattle. So often, nurses debate - to turn or not to turn patients who are dying. This is a somewhat passionate debate:

RN1: No, don't turn them. They're going to die soon. Why make them uncomfortable by fussing with them so much.

RN2: Yes, turn them. If they hang in there even for 24 hours, they could start getting bed sores and be in even worse pain than the turning causes them. Besides, if they're uncomfortable, premedicate them with morphine before turning them.

RN3: Yes, turn them. Because it also helps with decreasing death rattle.

RN4: No, I swear the death rattle sounded even louder after I turned her! That Mary, she is almost militant about turning her palliative care patients every two hours. That is ridiculous.

And the debate goes on and on. The more and more derisive, the more the judgements start appearing to make up for lack of knowledge on the subject. So... I want to get the knowledge to end the debate once and for all. And learn how to manage death rattle. Until now, my coworkers and I have relied primarily on educating family members that it is normal. But if, as No Milk stated, that is not in fact reassuring at all, clearly something more needs to be done.

So... off I went to the on-line medical libraries and found out that there are two different types of death rattle.

Type 1: caused by excessive salivary secretion and easily treatable with medications that cause a dry mouth

Type 2: caused by excessive bronchial secretions and NOT easily treatable

These two types also differ with regards to turning patients. Type 1 improves with turning. Type 2 does not improve and may in fact sound worse. Thus the explanation for the impassioned lectures on whether or not to turn. In some nurses experiences with death rattles of Type 1 nature, the turning has helped. In other nurses experiences with Type 2, it has gotten worse and more distressing for the family and probably for the nurse as well.

So, I won't write up my whole paper here, but I am just excited by this news and thought I'd share and explain my long abscence. See, my blog buddies inspire me and I can only blame you for my abscence. :-) Yeah, right. Well, speaking of explanations for my silence, I better get back to writing that paper.

Oh, and in case you're wondering, I think turning is very important in preventing pain from bed sores. And the type two death rattles need to be treated in another way which I am researching now.